Improving contraceptive decision support for individuals with chronic conditions

改善慢性病患者的避孕决策支持

• 批准号: 10733672
• 负责人: JUSTINE P WU
• 金额: $ 78.94万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-22 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10733672
• 关键词: Address; Adherence; Affect; Anemia; Awareness; Blinded; Body Weight Changes; Caring; Centers for Disease Control and Prevention (U.S.); Chronic; Chronic Disease; Clinic Visits; Clinical; Cluster randomized trial; Complex; Conflict (Psychology); Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Counseling; Data; Data Reporting; Decision Making; Development; Disease; Education; Enrollment; Epidemiology; Family Planning; Fatigue; Geography; Goals; Guideline Adherence; Guidelines; Health; Individual; Intervention; Interview; Maternal Health; Measures; Mediating; Mediator; Medical; Methods; National Institute of Child Health and Human Development; Online Systems; Outcome; Outcome Assessment; Patient Preferences; Patient Self-Report; Patients; Persons; Pilot Projects; Populations at Risk; Postpartum Women; Pregnancy; Pregnancy Complications; Probability; Procedures; Process; Psychometrics; Public Health; Published Comment; Reporting; Reproductive Health; Research; Resources; Risk; Self Management; Services; Side; Strategic Planning; Symptoms; Testing; Time; Uncertainty; Visit; Weight; Withdrawal; Woman; adherence rate; adverse pregnancy outcome; aged; arm; clinical care; clinical decision support; condoms; dalton; design; digital; efficacy evaluation; evidence base; experience; improved; innovation; novel; patient response; peer; person centered; primary care clinic; primary care practice; primary care provider; primary care setting; primary outcome; provider adherence; reproductive; secondary outcome; support tools; theories; tool; treatment arm; trend; unintended pregnancy; web-based tool

PROJECT ABSTRACT Women with pre-existing chronic conditions are more likely to experience unplanned pregnancy and pregnancy complications than their peers without chronic conditions. Because contraceptive nonuse (not using any contraceptive method) poses the greatest risk of unplanned pregnancy and is more prevalent among those with chronic conditions, there is an urgent need to support the contraceptive goals of this group. Contraceptive decision-making is a critical antecedent to contraceptive use, and a highly personal process. A significant clinical care gap is the lack of resources that address the unique contraceptive decision needs of patients with chronic conditions, such as understanding which methods may improve or worsen their symptoms (e.g., anemia) or disease self-management (e.g., weight). Patients should also know if their chronic conditions pose a health contraindication to a specific method, and if so, which other methods can be used safely. However, clinicians, including primary care providers, do not routinely elicit patient preferences or apply evidence-based contraceptive guidelines to counsel patients with chronic conditions. To address these gaps, we designed a web-based tool, My Health My Choice (MHMC), to educate patients with chronic conditions about their contraceptive options and promote clinician adherence to contraceptive guidelines from the Centers for Disease Control and Prevention (CDC). MHMC is innovative because it is the first theory- informed, user-tested contraceptive decision support tool that targets both patients with chronic conditions and their clinicians. Our long-term goal is to improve reproductive health through contraceptive interventions in general care settings. Building upon our promising pilot data, the study objective is to evaluate the efficacy of MHMC in a two-arm, parallel cluster-randomized trial using mixed methods to compare MHMC (intervention) to usual contraceptive care (control) in 14 primary care clinics that provide contraception. We hypothesize that MHMC use will improve patient-reported quality of contraceptive decision-making and quality of contraceptive counseling from their clinicians, which will lead to increased contraceptive use and decreased contraceptive nonuse. The study aims are: Aim 1(Primary): To evaluate the impact of MHMC on contraceptive nonuse. Aim 2 (Secondary): To assess the impact of MHMC on adherence to the CDC Contraceptive Guidelines using mixed methods. Aim 3: (Exploratory): To quantitatively explore decisional quality and contraceptive counseling as mediators of the effects of MHMC on primary and secondary measures. The expected outcomes are new findings regarding the efficacy of a novel contraceptive decision tool for individuals with chronic conditions. This project will inform the development of scalable, person-centered contraceptive interventions for medically at-risk patients in real-world clinical settings.

项目摘要 患有慢性疾病的妇女更有可能患有计划外怀孕和 怀孕并发症比没有慢性条件的同龄人。因为避孕不使用（不是 使用任何避孕方法）构成了计划外怀孕的最大风险，并且更普遍 在患有慢性病的人中，迫切需要支持该小组的避孕目标。 避孕决策是避孕药的至关重要的，并且是一个高度个人化的过程。一个 严重的临床护理差距是缺乏满足独特避孕决策需求的资源 患有慢性疾病的患者，例如了解哪种方法可能会改善或恶化其 症状（例如贫血）或疾病自我管理（例如体重）。患者还应该知道他们的慢性 条件对特定方法构成健康禁忌症，如果是，则可以使用其他方法 安全。但是，包括初级保健提供者在内的临床医生不会通常引起患者的偏好或 将基于证据的避孕指南咨询患有慢性疾病的患者。解决这些 差距，我们设计了一种基于网络的工具，我的健康我的选择（MHMC），以教育慢性病患者 有关其避孕方法的条件，并促进临床医生遵守避孕指南 疾病控制与预防中心（CDC）。 MHMC具有创新性，因为它是第一个理论 - 知情，用户测试的避孕决策支持工具，针对患有慢性疾病的患者和 他们的临床医生。我们的长期目标是通过避孕干预措施改善生殖健康 一般护理环境。在我们有希望的飞行员数据的基础上，研究目标是评估 MHMC在使用混合方法比较MHMC（干预）的两臂平行聚类随机试验中 在提供避孕的14个初级保健诊所中通常的避孕护理（控制）。我们假设这一点 MHMC使用将改善患者报告的避孕决策质量和避孕质量 他们的临床医生的咨询，这将导致避孕药的增加和避孕药减少 不使用。该研究的目的是：目标1（主要）：评估MHMC对避孕不使用的影响。目的 2（次要）：评估MHMC对使用CDC避孕准则遵守的影响 混合方法。目标3 ：（探索）：定量探索决策质量和避孕 作为MHMC对初级和次要措施的影响的辅导。预期 结果是关于新颖的避孕决策工具的新发现 慢性条件。该项目将告知开发可扩展的，以人为本的避孕药 在现实世界中临床环境中医学风险患者的干预措施。